Clinical Geriatrics

Trends in the Use of CAM in the United States
The use of complementary and alternative medicine (CAM) in the United States is increasing rapidly, exceeding a prevalence of 60% in a nationally representative survey conducted by the National Center for Health Statistics in 2002.^1,2 CAM therapies are defined by the National Center for Complementary and Alternative Medicine as a group of diverse medical and health systems, practices, and products that are not currently considered to be part of conventional medicine.³ An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. A national U.S. survey noted a 47% increase in total visits to CAM practitioners, from 427 million in 1990 to 629 million in 1997.³ Estimated expenditures for CAM professional services were conservatively estimated at $21.2 billion in 1997, with at least $12.2 billion of out-of-pocket expenditures, exceeding out-of-pocket expenditures for all U.S. hospitalizations.³ In a more recent nationwide survey, 36% of U.S. adults age 18 years and older use some form of CAM, and aging baby boomers are expected to accelerate the use of CAM in the coming years.⁴

Despite the increasing use of CAM by individuals, the scientific support for its efficacy is limited. The treatments with the best evidence of effectiveness are St. John’s wort, exercise, and light therapy (for seasonal depression). There is only some degree of evidence to support the effectiveness of acupuncture, light therapy (for nonseasonal depression), massage therapy, negative air ionization (for winter depression), relaxation therapy, S-adenosyl-L-methionine, folate, and yoga breathing exercises.⁵

Use of CAM therapies is typically associated with higher levels of education, poorer health status, environmentalism, feminism, and interest in spirituality and personal growth psychology.⁶ Barnes and colleagues⁴ noted that nearly 33% of older adults used CAM in the preceding year. In their survey, 42% of the patients in a managed care organization reported using at least one CAM therapy, most commonly relaxation techniques (18%), massage (12%), herbal medicine (10%), or megavitamin therapy (9%).⁴

This review is devoted to the description of the evidence-based CAM treatments applied to the care of older adults with late-life mood disorders (Table). We will discuss some of the more commonly used interventions.

Use of CAM in Late-Life Mood Disorders
Mood disorders are the most frequently occurring psychiatric syndromes in older adults. Depressive symptoms occur in approximately 10-15% of patients in primary care settings. The prevention and treatment of depression are important areas to define: depression is linked to cognitive decline and is considered to cause a worldwide health burden greater than that of ischemic heart disease, cerebrovascular disease, or tuberculosis.

Mood disturbances are commonly observed in patients with neurodegenerative disorders including probable Alzheimer’s disease (AD), Parkinson’s disease (PD), and post-stroke depression. Clinically, preference is given to therapy with antidepressants that do not have a significant anticholinergic effect. Other treatment strategies include treatment of pain and infection, environmental and behavioral management, and professional caregiver training. Despite rigorous research, the response to these therapies remains only modest and partial for most patients. While CAM treatments are widely used by consumers, very little research is available to guide patients and their caregivers—or even practitioners in the field. The perceived helpfulness of CAM therapies is similar to that of conventional therapies.^2,5

St. John’s Wort (Hypericum perforatum)
St.